Whistle while you work

Staff are often the first to suspect or spot bad practice, so it is important that they are encouraged to speak, writes Graham Hopkins

The Commission for Social Care Inspection states boldly that one of its jobs is to “stamp out bad practice”. Having worked in regulation I know that inspection rarely reveals poor practice, but is more likely to be exposed through service user complaints, or staff whistleblowing. “Staff tend to be the first to know that there is a problem because they are working closest to it,” says Anna Myers, deputy director of Public Concern at Work (Pcaw).

“The issue is, does that information get to the individuals who need to know; either those at risk or those who can prevent the risk continuing or the damage happening.”

Pcaw is a charity that runs a free confidential helpline for anyone concerned about wrongdoing at work and who is unsure whether or how to raise it. When the idea of such an organisation was mooted in 1990, “whistleblowing” was seen largely in a hostile light. The term was generally applied to public officials who had leaked information, usually to the media, and paid a heavy price for so doing. Whistleblowers were seen as loners and losers.

However, inquiries into disasters such as the sinking of the Herald of Free Enterprise, the Clapham rail crash and the collapse of Bank of Credit and Commercial International each revealed that staff had been aware of the danger but had not felt able to raise the matter internally or to pursue it if their concern was not taken seriously.

Also it transpired that nobody was accountable for what had happened. “In setting up Pcaw, we wanted to demonstrate the link between whistleblowing and accountability and to signal the need to break with a culture that fostered complacency and cover-ups,” says Myers.

An important first step is for organisations to say clearly and upfront why it’s important that staff do speak up. “This route may be blocked or people feel unable to raise it,” explains Myers. “They might think their manager is in some way condoning it or somehow involved, or they don’t want to embarrass or feel they need to protect them.

“The alternatives are to say nothing at all or find another way to speak up – to another senior person in the organisation or take an external route, such as CSCI.” However, research published last year by the Ann Craft Trust charity and the centre of social work, University of Nottingham, Blowing the Whistle on Abuse of Adults with Learning Disabilities, found that organisational culture and power relationships within care settings can work against an ethos of raising concerns.

“For new workers in particular,” says researcher Rebecca Calcraft, “it can be difficult to recognise what constitutes abuse without developing knowledge of the issues through training and experience.

Established teams of care staff may tolerate poor or abusive practices, and this can be very difficult for new workers to challenge. Although working together is important to provide quality care, close knit teams should not automatically be seen as a positive feature, as a closed culture can serve to silence questions and concerns.”

She continues: “We also came across several cases involving concerns about powerful individuals who had developed a dominant role within a care setting and whose behaviour towards colleagues and service users was inappropriate. It’s important that managers establish an ethos that does not allow such individuals to dominate a team.”

Generally, Myers argues, if someone has concerns about abuse of vulnerable adults they often raise them. “It’s seen as themdoing their jobs well, and nobody stops to call it ‘whistleblowing’.”

Indeed, the Cornwall scandal was a text book example of whistleblowing (and it has to be said about the reluctance of those in authority to take things seriously, at least initially). However, the official report does not use the word at all.

Myers says the Pcaw helpline has always had more calls from the health and social care sector than any other: “This might well be because of its size, the risks are more personal and workers know more about us. I think it is one of the most important sectors for people to speak up.”

Helpline figures show that 30 per cent of calls come from the health and care sector. “Last year, 14 per cent of the public concerns we advised on were about abuse in care,” she adds.

It is alarming that such numbers are willing to take things further but feel unable to speak up at work. It’s not a regulator’s job alone to stamp out bad practice, it’s everyone’s job. But, as with all jobs, workers need to be supported to do their jobs well.

TOP TIPS● Acknowledge how difficult it can be for a worker to blow the whistle.● Offer whistleblowers practical and emotional support.● Concerns raised need to be handled sensitively.● While confidentiality must be guaranteed where requested, keep whistleblowers informed of progress.● Managers must debrief and supporting the staff team as a whole.

Whistleblowing case studySarah Drake*, a care assistant in small nursing home, worked for years with Fred Harris*, a senior nurse on the dementia unit, whom she considered a friend. One day, Sarah noticed that Fred had begun to treat residents poorly.

Having heard Fred shout at a resident one evening Sarah discovered that a difficult elderly man was being sedated without a prescription. Fred said that the doctor would soon prescribe it and he was just giving everyone some peace. One night, when an elderly woman got out of bed shouting, Sarah saw Fred put his hands briefly around her neck before pushing her back into her room.

Sarah then heard screams coming from behind the door.

The home had a new manager whom Sarah did not know well. She felt isolated and concerned, but following a friend’s advice called Pcaw’s helpline.

Sarah was advised to write down the incidents as accurately as possible and asked if she felt able to speak to her manager. Sarah admitted that the manager appeared to take matters of care seriously and that she wanted to speak to him first, before going to the care inspectors.

Pcaw advised Sarah to request a private meeting with the manager to explain why she was worried. She did so the following day and the manager began an immediate investigation. Though initially denying a problem, other staff soon began to describe incidents that Sarah knew nothing about.

Fred was suspended, the police were called in and ten months later he was convicted and jailed for two years.

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